Cytomegalovirus infection in renal transplant recipients

We have retrospectively analyzed the incidence of cytomegalovirus (CMV) infection in 250 consecutive renal allograft transplants performed in 244 recipients. The mean follow-up was 35.1 ± 25.4 months. Immunosuppression was cyclosporine- or tacrolimus-based triple therapy. CMV infection prophylaxis with ganciclovir for 3 months post transplant was prescribed in CMV-seronegative recipients of allografts from seropositive donors (D + R -) and in all recipients treated with OKT3. CMVantigenemia was monitored by the pp65 -antigen assay. Thirteen of 57 D + R -recipients (22.8°o) developed CMVantigenemia. One recipient had a breakthrough of CMVantigenemia during ganciclovir prophylaxis; 12 D + R - recipients developed CMVantigenemia 147.5 ± 173.8 days after transplantation. Four of 13 (30.7%) D + R - recipients had asymptomatic CMV infection, 8 (61.6%) had CMV infection with nonspecific symptoms including fever, and 1 (7.7%) developed CMV pneumonia. Six of 13 (46.1%) D + R - patients had been treated with intensified immunosuppressive therapy before CMV infection. In the low-risk CMV groups (D + R +; D - R +; D - R -), 28 recipients (14.5%) developed CMVantigenemia 42.5 ± 15.2 days post transplantation. Ten of the 28 (35.7%) recipients had asymptomatic CMV infection, 17 (60.7%) developed CMV infection with nonspecific symptoms, and 1 (3.6%) developed CMV pneumonia. Twenty-one of 28 (75.0%) had intensified immunosuppressive therapy before CMV infection. In conclusion, ganciclovir prophylaxis diminished and delayed the onset of CMV infection but did not totally prevent it from occurring in D + R - renal transplant recipients. Clinicians should be vigilant to the possibility of CMV infection in both seronegative and seropositive recipients, especially after antirejection therapy.